RS Illingsworth statement, "Teething produces nothing but teeth." is a straightforward summation of the actual process of teething. (4) Many conditions previously thought to be caused by teething like uncontrolled vomiting, weight loss, septicemia, tonsillitis, infantile paralysis, cholera, meningitis and tetanus are now accurately diagnosed after significant diagnostic and therapeutic medical advancement. But the enigma of teething continues to endure as a wastebasket diagnosis, when no cause can be found for a particular sign or symptom. Continued worldwide education about teething and diarrhea is needed to ensure that infants and children are treated appropriately and safely. Among medical professionals, pediatricians attribute the fewest symptoms to teething and paramedic staff the most. Dentists also are more likely to attribute a greater variety of symptoms, including diarrhea, to teething, likely due to a lack of exposure to young children and because diarrhea is not part of dental training. Parents are bound to discuss teething with the dentist when their children are evaluated.

Symptoms:

Many unexplained teething myths continue to pervade contemporary child health. The period associated with the eruption of the deciduous teeth in infants can be difficult and distressing for both the child and their respective parents. The eruption of the deciduous teeth is accompanied by a number of relatively minor symptoms (Table 3). General irritability, disturbed sleep, gum inflammation, drooling, loss of appetite, diarrhea, circumoral rash, intra-oral ulcers, an increase in body temperature, increased biting, gum-rubbing, sucking, wakefulness and ear-rubbing, have all been identified as being temporally related to teething. (5-9) Decreased appetite for solid foods and mild temperature elevation (<38.9⁰C) also have been reported. (9)

Studies could not identify systemic manifestations such as decreased appetite for liquids, congestion, sleep disturbances, daytime restlessness, loose stools, vomiting, cough, body rash, fever greater than 38.9⁰C, an increase in finger-sucking, and gum rubbing to be associated with teething in children. (10,11). Macknin et al (1) and Wake et al (8) failed to associate above mentioned symptoms with tooth eruption. Carpenter found that in 120 subjects, during the eruption of the mandibular deciduous central incisor teeth, only 39% exhibited one of several symptoms (fever, vomiting, diarrhea, drooling, irritability, facial rashes or rhinorrhea), and the symptoms disappeared on either the day of, or the day after eruption of the tooth. (12)

Table 3. Signs and Symptoms of Teething:

• Pain
• Inflammation of the mucous membrane overlying the tooth (possibly with small hemorrhages)
• General irritability/malaise
• Disturbed sleep/wakefulness
• Drooling/sialorrhea
• Gum rubbing/biting/sucking
• Bowel upset (ranging from constipation to loose stools and diarrhea)
• Loss of appetite/alteration in volume of fluid intake
• Ear rubbing on the same side as the erupting tooth

Parents hold a spectrum of opinions regarding the teething-associated symptoms. Wake et al. found that between 70-85% of parents reported teething was related to fever, pain, irritability, disturbed sleep, and biting, drooling and red cheeks. Furthermore, between one-third and one-half of parents felt that nappy rash, 'soaking', ear pulling, feeding difficulties, a runny nose, loose stools, and infections were related to teething, whereas a few parents related smelly urine, constipation, colic and convulsions to eruptive difficulties. (13)

In a survey among pediatricians, Honig found that only 5 of 64 pediatricians believed that irritability, eating problems, wakefulness and rashes were not consequent to teething, and 18 pediatricians thought that fevers of up to 39⁰C could be caused by teething. (14) British Medical Journal editorial (1975) stated that fever, diarrhea, rashes, fits, and bronchitis should not be attributed to teething. Pediatricians that diagnose these symptoms and signs as teething were delaying the diagnosis and treatment of pyogenic meningitis, bronchopneumonia, gastroenteritis, urinary tract infections and other serious disorders. (15)

Despite this information, Swann examined the records of 50 children admitted to hospital with symptoms attributed to teething by either parents or doctors. (16) In 48 of these children, organic causes like upper respiratory tract infections, febrile convulsions, bronchitis, eczema and meningitis were identified.